Introduction
Adrenal glands are present above the kidneys. They are triangular in shape. They are small endocrine glands that are responsible for producing hormones like aldosterone, adrenaline, and cortisol. These glands have to function well to maintain blood pressure, regulating the immune and metabolic functions. It includes two different parts, and they are namely, the adrenal cortex and adrenal medulla. Each of these parts plays a vital role in performing its own specific function.
What Is Cortisol?
Cortisol is an important hormone that is released during times of stress. It also elevates the level of blood sugar by a process called gluconeogenesis. Cortisol also aids in the metabolism of carbohydrates, fat, and proteins. It also regulates bone formation. It plays a remarkable role in releasing inflammatory substances. In this way, the overactivity of the B-cells can be controlled. It also helps in treating eczema and skin rashes. The cortisol level has to be regulated at an average level for the organ system's proper functioning.
What Is the Adrenal Crisis?
An adrenal crisis is a complicated condition that requires immediate medical care. An adrenal crisis happens when there is a lower level of hormones, such as cortisol. The cortisol level decreases in the following cases:
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Addison's Disease - It is a condition in which there is a rapid loss of adrenal function.
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Congenital Adrenal Hyperplasia - It is an autosomal disorder in which the synthesis of cortisol is impaired.
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Waterhouse-Friderichsen Syndrome - In this condition, there is a failure in the function of adrenal glands due to severe bleeding.
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Mental or physical stress.
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Any injury or trauma.
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Severe infections.
What Are the Signs and Symptoms of Adrenal Crisis?
The common signs and symptoms of adrenal crisis are:
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Severe lethargy.
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Loss of consciousness.
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Sudden pain in the abdomen, lower back, or legs.
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Confusion, slurred speech, and psychosis.
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A condition of hypothyroid results due to the low levels of T4.
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Severe vomiting and diarrhea.
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Dehydration.
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Fever.
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Convulsions.
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Pain in the muscles.
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Joint pain.
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Loss of sexual interest in women.
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Hair loss.
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Hyperpigmentation of the skin.
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Weight loss.
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Hyperkalemia - In hyperkalemia, there is an elevated potassium level in the blood.
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Hypercalcemia - In this condition, the level of calcium is increased. In severe conditions, the removal of calcium by the kidney is disrupted, and the glomerular filtration rate is significantly reduced.
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Hypotension - It is a condition in which the blood pressure falls more than the normal levels.
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Hyponatremia - In hyponatremia, the level of sodium becomes decreased in the blood.
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Hypoglycemia - It is a condition in which there is a reduced level of blood glucose.
What Are the Complications of the Adrenal Crisis?
The main complication of the adrenal crisis is the Addisonian crisis. In the Addisonian crisis, the patient experiences severe abdominal pain and dehydration. The serum sodium level is greatly reduced, and the serum potassium level is increased. It might also result in the collapse of the patient.
How Is the Adrenal Crisis Diagnosed?
The doctor will recommend performing a few diagnostic tests to identify the condition of adrenal crisis. They are:
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ACTH (Adrenocorticotropic Hormone) Stimulation Test - This test helps in detecting the levels of cortisol. This test focuses on the stimulation or injection of adrenocorticotropic hormone. If it is given in an injection, the synthetic adrenocorticotropic hormone is used. The level of cortisol serves as an indicating sign of adrenal crisis.
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Insulin-Induced Hypoglycemia Test - If the doctor suspects the cause of the adrenal crisis is a pituitary disorder, the doctor will recommend this test. In the insulin-induced hypoglycemia test, the blood sugar level and cortisol level are noted after insulin injection. In a normal and healthy individual, cortisol levels increase, and sugar decreases after giving the injection. If the cortisol level decreases and the glucose level becomes abnormal, it might be an adrenal crisis.
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Routine Blood Test - A blood test is performed to measure cortisol levels, potassium, sodium, and adrenocorticotropic hormone. A blood test will also help detect the antibodies that are developed in the body against Addison's disease.
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Computed Tomography Scan (CT Scan) - In a computed tomography scan, abnormalities in the adrenal gland can be identified with respect to size and shape. Any tumor conditions associated with the adrenal gland can also be detected.
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Magnetic Resonance Imaging Scan (MRI Scan) - Pituitary gland disorders are known to be the cause of the adrenal crisis. In order to understand the abnormalities in the pituitary glands, the doctor will recommend an MRI scan.
What Are the Treatment Options for Adrenal Crisis?
The treatment procedures involve the following:
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Medications - Hormonal replacement therapy can be performed to bring the level of steroid hormones to normal levels. If steroid hormones are not produced, even in such conditions, hormonal replacement therapy is helpful. Oral corticosteroids such as Prednisone, Hydrocortisone, and Methylprednisolone can be used to replace cortisol. Aldosterone can be replaced with Fludrocortisone acetate supplements. The dosage must be consumed according to the doctor's recommendation. If the medications are not helpful, one can consult the doctor for suggestions for alternative medicine.
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Lifestyle Modifications - One should change the eating patterns and lifestyle. Salt should be added to the diet at higher levels. This should be followed, particularly when one has diarrhea. It can be followed in cold climatic conditions also. One must perform exercises to keep the body healthy. Leading a stress-free environment prevents one from further complications. It is recommended to do yoga and meditation. It is essential to have regular checkups with the doctor.
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Corticosteroids - In emergencies, the patient should be admitted to the hospital, where they will be given intravenous injections of saline solution or corticosteroids.
How Is the Prognosis for the Adrenal Crisis?
The prognosis for the adrenal crisis is good if the patient cooperates well with the treatment. The time taken for the recovery might range from six months to one year. If the patient has undergone surgery, then it might take a long time for them to heal.
Conclusion
An adrenal crisis is a potentially fatal medical emergency that requires prompt diagnosis and treatment. It results from inadequate adrenal hormone synthesis, which is frequently brought on by underlying diseases like Addison's disease or extremely stressful situations. Rapid intravenous glucocorticoid therapy and fluid administration are required due to clinical symptoms, which include severe hypotension, electrolyte abnormalities, and disturbed mental status. To reduce morbidity and death, early detection and fast treatment are essential. Patients with known adrenal insufficiency need to recognize how important stress dosage steroids are, as well as the value of having emergency supplies. Effective management of adrenal crises depends heavily on alertness and quick action.
